| Mid Valley Vascular Center, Inc | |
|
7640 Tampa Ave Suite 101a Reseda CA 91335-1735 | |
| (818) 718-1600 | |
| (818) 343-1612 |
| Full Name | Mid Valley Vascular Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7640 Tampa Ave, Reseda, California |
| Authorized Official Name and Position | Leo Polosajian (PRESIDENT/CEO) |
| Authorized Official Contact | 8184543638 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid Valley Vascular Center, Inc 4930 Balboa Blvd Suite 261278 Encino CA 91426-7001 Ph: (818) 718-1600 | Mid Valley Vascular Center, Inc 7640 Tampa Ave Suite 101a Reseda CA 91335-1735 Ph: (818) 718-1600 |
| NPI Number | 1790187169 |
|---|---|
| Provider Enumeration Date | 09/17/2014 |
| Last Update Date | 11/05/2014 |
| Medicare PECOS PAC ID | 5395967186 |
|---|---|
| Medicare Enrollment ID | O20141111001439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790187169 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Feliciano A Serrano |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1649225558 PECOS PAC ID: 3173588787 Enrollment ID: I20041123000571 |
| Provider Name | Leo Polosajian |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174664783 PECOS PAC ID: 9436050580 Enrollment ID: I20070829000769 |
| Provider Name | Sam J Kalioundji |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1619129426 PECOS PAC ID: 5294876033 Enrollment ID: I20150310002567 |
| Provider Name | Robert Azizi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316101298 PECOS PAC ID: 3779872981 Enrollment ID: I20160511001425 |
| Provider Name | Catherine Garganera-quinzon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902253792 PECOS PAC ID: 3779857404 Enrollment ID: I20170919004108 |
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